Zayas G J, Bonilla A M, Saliba M J
Mucobiology Research Center, University of Alberta, Edmonton, Canada.
Ann Burns Fire Disasters. 2007 Mar 31;20(1):29-34.
Objectives. In El Salvador, before 1999, morbidity and mortality in severely burned children were high. In 1998, all children with burns of 40% or larger size died and sepsis was found. With heparin use in 1999, some similarly burned children survived, and sepsis, pain, procedures, and scars were noted to be less. This retrospective study presents the details. Methods. A study was conducted at the National Children's Hospital in El Salvador of all children with burns over 20% size treated in 1998, when no heparin was used, and in 1999, when heparin was added to burns treatment, using an ethics committee approved protocol in use in twelve other countries. Sodium aqueous heparin solution USP from an intestinal source was infused intravenously and applied topically onto burn surfaces and within blisters for the first 1-3 days post-burn. Then heparin, in diminishing doses, was continued only topically until healing. The treatments in 1998 and 1999 were otherwise the same, except that fewer procedures were needed in 1999. Results. There were no significant differences in gender, age, weight, burn aetiology, or burn size between the burned children in 1998 and those in 1999. Burn pain was relieved and pain medicine was not needed in children treated with heparin in 1999. In 1998, one child survived who had a 35% size burn, and the eight children died who had burns of 40% and over. The survival rate was one out of nine (11%). The average burn size was 51.7%. With heparin use in 1999, six of the ten children survived burns of 50.7% average size. The increase in survival with heparin from 11% to 60% and, therefore, the decrease in mortality from 89% to 40% were significant (p < 0.04). Clinical symptoms and positive blood cultures documented bacterial sepsis in the nine children in 1998. In 1999, the blood cultures for sepsis were positive in the four children who died and negative in the six who survived. The nine versus four differences in the incidence of sepsis between 1998 and 1999 was significant (p < 0.008). The survivors had notably smooth skin. Conclusions. The use of heparin in this study relieved burn pain, significantly reduced mortality and sepsis with fewer procedures, and discernibly improved cosmetic results.
目的。在萨尔瓦多，1999年以前，严重烧伤儿童的发病率和死亡率很高。1998年，所有烧伤面积达40%及以上的儿童均死亡，且发现有败血症。1999年使用肝素后，一些烧伤情况类似的儿童存活了下来，且败血症、疼痛、手术次数和疤痕都有所减少。本回顾性研究详述了相关情况。方法。在萨尔瓦多国立儿童医院，对1998年（未使用肝素）和1999年（烧伤治疗中添加肝素）所有烧伤面积超过20%的儿童进行了一项研究，采用了经伦理委员会批准、在其他12个国家使用的方案。从肠道来源获取的肝素钠水溶液USP在烧伤后第1至3天通过静脉输注，并局部应用于烧伤表面和水泡内。然后，逐渐减少剂量的肝素仅继续局部使用直至愈合。1998年和1999年的治疗在其他方面相同，只是1999年所需的手术较少。结果。1998年和1999年烧伤儿童在性别、年龄、体重、烧伤病因或烧伤面积方面无显著差异。1999年接受肝素治疗的儿童烧伤疼痛得到缓解，无需使用止痛药物。1998年，一名烧伤面积为35%的儿童存活，八名烧伤面积达40%及以上的儿童死亡。存活率为九分之一（11%）。平均烧伤面积为51.7%。1999年使用肝素后，十名儿童中有六名在平均烧伤面积为50.7%的情况下存活。肝素使存活率从11%提高到60%，死亡率从89%降至40%，差异显著（p < 0.04）。1998年有九名儿童的临床症状和血培养结果证实有细菌败血症。1999年，死亡的四名儿童血培养结果显示败血症呈阳性，存活的六名儿童血培养结果为阴性。1998年和1999年败血症发病率的九例与四例差异显著（p < 0.008）。幸存者的皮肤明显光滑。结论。本研究中肝素的使用缓解了烧伤疼痛，显著降低了死亡率和败血症发生率，减少了手术次数，并明显改善了美容效果。
